Intestinal Stenosis Secondary to Grade IV Endometriosis: A Case Report

Intestinal stenosis secondary to deep endometriosis grade four is an uncommon presentation that often leads to delayed diagnosis and challenging therapeutic decisions. We report the case of a 41-year-old woman with long-standing pelvic pain, dysmenorrhea, and alternating constipation and diarrhea, with a history of surgery for endometriosis. The aim is to describe the diagnostic and therapeutic pathway and to highlight practical lessons for clinical care. Clinical assessment and blood tests revealed mild anemia. Colonoscopy showed a narrowed sigmoid colon with intact mucosa, and contrast-enhanced computed tomography demonstrated an abrupt caliber transition and focal wall thickening. Management consisted of a multidisciplinary-planned segmental intestinal resection. Histopathology confirmed endometrial glands and stroma infiltrating the muscular layer with fibrosis and no atypia. Follow-up documented improvement of obstructive symptoms and absence of immediate complications. This case contributes an integrated view of endoscopic, radiologic, and pathological findings explaining stenosis caused by extrinsic involvement of the bowel wall. The key lesson is to maintain a high index of suspicion for intestinal endometriosis in women of reproductive age with cyclic gastrointestinal symptoms and stenosis without mucosal disease, emphasizing multidisciplinary evaluation and histological confirmation to timely define surgical treatment.